____________(Date)

THE MANAGER
_________(Bank)
__________ (Branch)
____________(Address)

Dear Sir:

In connection with the examination of our accounts/financial statements as of December 31,

2017, please furnish our auditors, COMMISSION ON AUDIT, the balances and details of our accounts
with you at that date in the form below. Your prompt compliance with this request will be greatly
appreciated.

Very truly yours,

________________(Agency)
By:

________________(Agency Head)
Chairman and Chief Executive Officer

RE: PHILIPPINE AMUSEMENT AND GAMING CORPORATION

1. We hereby report that at the close of business on December 31, 2017, our records showed the
following balances to the credit of above-mentioned client:

INTEREST
DESCRIPTION OF ACCOUNT RESTRICTION ON WITHDRAWAL OF
AMOUNT RATE PAID UP ACCOUNT AND OTHER REMARKS
ACCOUNT NUMBER
(PA) TO
Regular Checking Acct.
Savings Deposits
Time Deposits Due Dates:
Due Dates:
Money Market
Placements
Escrow Account
Other Account

2. Direct Liabilities, assets and related balances of said Other accounts with the bank on the data
were:
Client at the above mentioned date were as follows: (details attached)
(Attached details by LCs)

AMOUNT a. Securities held for safekeeping

ACCOUNT FOR. CURRENCY PESO b. Items held for collection
Acceptances c. Trust account
Drafts d. Others (specify)
Trust Receipts
Marginal Deposits

3. We further report that the above-mentioned client was directly liable to us by way of overdrafts, loans,
etc. at the close of business on that date as follows:

INTEREST
DESCRIPTION OF DATE DESCRIPTION OF COLLATERALS,
AMOUNT GRANTED PAID UP LOANS, OTHER REMARKS
LIABILITIES
RATE(PA) TO
Overdrafts
Loans
Other (Specify)

4. Other direct and/or contingent liabilities were:

DESCRIPTION DATE OF
AMOUNT OF ACCOUNT NAME OF MAKER NOTE DUE DATE REMARKS

Except as stated above, according to our records, said client had no other account with us at the above-
mentioned date.

Yours truly,
( BANK )– ______ Branch
By:
Date filled in:
N.B. If the space provided is inadequate, please enter totals hereon and attach a statement giving full details as
called for by the above columnar heading. If the answer to any item is “NONE’, please so state.